Dear Marci,
I want to get a flu shot, but I’m not sure if it will be covered by Medicare. Does Medicare cover flu shots?
– Norma (Las Cruces, NM)
Dear Norma,
Yes, Medicare covers flu shots. Medicare Part B, the part of Medicare that covers most outpatient services, covers a flu shot once every flu season. The flu season typically runs from November until April. This means that Medicare may cover a flu shot twice in one calendar year. For example, if you get a shot in January 2016 for the 2015-2016 flu season, you could get another shot in November 2016 for the 2016-2017 flu season.
The flu shot is covered by Medicare Part B as a preventive service. This means that you will not have to meet your Part B deductible in order for Medicare to cover your flu shot. This is true whether you get your Medicare benefits through Original Medicare or a Medicare Advantage Plan.
If you have Original Medicare, you can get your flu shot from any health care provider, such as a doctor or pharmacy, as long as the provider accepts Medicare. You will pay nothing for a seasonal flu shot if you go to a provider that accepts Medicare and takes assignment. A provider that takes assignment accepts the Medicare-approved amount for health care services as full payment. If you see a provider who does not take assignment, you may have an out-of-pocket cost for your flu shot. You can call 1-800-MEDICARE or contact your health care provider to learn whether your health care provider accepts Medicare and takes assignment. The majority providers throughout the United States take assignment.
If you have a Medicare Advantage Plan, your plan should pay for the entire cost of the flu shot as long as you follow the plan’s rules. For example, a plan may agree to pay for the entire cost of your flu shot, as long as you receive it from doctors or pharmacies that are within the plan’s network. Although a plan may impose some requirements, it cannot require you to get a referral before it will cover the cost of the flu shot.
– Marci